Debates over the Affordable Care Act have evolved in Washington, D.C., moving away from "repeal and replace" toward navigating premium subsidies set to expire at the end of 2025, The Washington Post reported Sept. 12.
The ACA surfaced as a topic near the end of the Sept. 10 debate between former President Donald Trump and Vice President Kamala Harris. Mr. Trump was asked if he still intended to replace the healthcare law ― and if so, what the plan is. When pressed, Mr. Trump said he has "concepts of a plan" and that he "would only change it if we come up with something better and less expensive." "And there are concepts and options we have to do that," he added. "And you'll be hearing about it in the not-too-distant future."
The Republican Party has shifted away from its longstanding campaign to repeal the ACA, passed under President Barack Obama in 2010. However, the healthcare law re-emerged in the election cycle when Mr. Trump in November used Truth Social to identify healthcare as a key issue in his 2024 campaign, promising to replace the ACA if re-elected.
The ACA marketplace is the fastest growing segment in the health insurance industry. Over 20 million people have enrolled in individual insurance plans on an exchange for 2024, a record high. Marketplace growth is being partly driven by federal premium subsidies that exist through the end 2025, which enable more low-income inidivuals to purchase coverage.
But making the subsidies permanent would add $335 billion to the national deficit between 2025 and 2034, the Congressional Budget Office estimated in June. Without them, enrollment would decline.
According to the Post, ACA subsidies are unlikely to become a part of the presidential campaigns of either party this year.
"It’s too complicated,” Debbie Curtis, a vice president at consultancy McDermott+, told the newspaper. "I see what’s happening right now as laying the groundwork for the big fight next year."
Republican lawmakers have recently expressed concerns about fraud on ACA exchanges, saying that third-party platforms make it easier for unauthorized brokers to make changes to enrollees' plans that they did not authorize. In May, CMS said it received 40,000 complaints of unauthorized plan switches in the first three months of 2024, of which around 39,000 have been resolved.
In July, CMS blocked agents and brokers from making changes to an individual's exchange enrollment status unless they are already associated with that enrollment. Unassociated or "new" agents and brokers will need to conduct a three-way call with the consumer and an agency call center to make any changes, or direct the enrollee to make the changes themselves.